Lubna Pal1, Sangita Jindal, Barry R Witt, Nanette Santoro. 1. Department of Obstetrics and Gynecology and Women's Health, Albert Einstein College of Medicine, Bronx, New York, USA. lubnapal@hotmail.com
Abstract
OBJECTIVE: To determine if attempts to maximize oocyte yield during ovarian stimulation translates into improved outcome of in vitro fertilization (IVF) cycles. DESIGN: Retrospective study. SETTING: Academic tertiary care IVF center. PATIENT(S): 806 de-identified nondonor IVF cycles. INTERVENTION(S): Evaluation of fresh nondonor IVF cycles (n = 806) for the period January 1, 1999, to December 30, 2001. MAIN OUTCOME MEASURE(S): Cycle cancellation, clinical pregnancy, spontaneous miscarriage, and live birth after IVF. RESULT(S): Advancing age, independent of ovarian reserve status (reflected by early follicular phase FSH and estradiol) augured a worse prognosis for all outcomes. Higher gonadotropin use lowered cycle cancellations but was associated with a statistically significantly reduced likelihood of clinical pregnancy and live birth and a trend toward a higher likelihood for spontaneous miscarriage after IVF. CONCLUSION(S): Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.
OBJECTIVE: To determine if attempts to maximize oocyte yield during ovarian stimulation translates into improved outcome of in vitro fertilization (IVF) cycles. DESIGN: Retrospective study. SETTING: Academic tertiary care IVF center. PATIENT(S): 806 de-identified nondonor IVF cycles. INTERVENTION(S): Evaluation of fresh nondonor IVF cycles (n = 806) for the period January 1, 1999, to December 30, 2001. MAIN OUTCOME MEASURE(S): Cycle cancellation, clinical pregnancy, spontaneous miscarriage, and live birth after IVF. RESULT(S): Advancing age, independent of ovarian reserve status (reflected by early follicular phase FSH and estradiol) augured a worse prognosis for all outcomes. Higher gonadotropin use lowered cycle cancellations but was associated with a statistically significantly reduced likelihood of clinical pregnancy and live birth and a trend toward a higher likelihood for spontaneous miscarriage after IVF. CONCLUSION(S): Our data add to the accruing literature suggesting adverse influences of excess gonadotropin use on IVF outcomes. Although an aggressive approach to controlled ovarian hyperstimulation results in a statistically significant reduction in cycle cancellations, the excessive use of gonadotropins detrimentally influences live birth after IVF.
Authors: Meleen Chuang; Athena Zapantis; Martina Taylor; Sangita K Jindal; Genevieve S Neal-Perry; Harry J Lieman; Alex Joel Polotsky Journal: J Assist Reprod Genet Date: 2010-09-07 Impact factor: 3.412